Time Management: A Realistic Approach

Article Outline

  1. Introduction
  2. The Basics of Time Management
    1. Goals
    2. Organization
    3. Delegation
    4. Relaxation
    5. Ditch Guilt
  3. Summary
  4. References

Realistic time management and organization plans can improve productivity and the quality of life. However, these skills can be difficult to develop and maintain. The key elements of time management are goals, organization, delegation, and relaxation. The author addresses each of these components and provides suggestions for successful time management.

Long hours are not a substitute for efficiency. Tasks not worth doing at all are not worth doing well.

—Alexander R. Margulis [1]


We have all been there: busy with our jobs and taking care of our families, we have to-do lists a mile long. If we are lucky, when we stumble into bed at night, we might have crossed off a handful of tasks. We have trouble sleeping as we think about all of the things we failed to do. For some reason, in the middle of the night, the size of these tasks is exaggerated. When we get up the next day, we are sleep deprived and racked with guilt, ready to begin yet another day of being behind. This vicious cycle goes on day after day, month after month, year after year. In this age of 24/7 connectivity, if we take a “vacation,” we continue to do work, and if we don’t, we feel guilty. The fatigue, disorganization, and sense of loss of control usually leads to reduced productivity and quality of our efforts, both professional and personal. The stress and anxiety take up valuable time and energy. Anxiety eats brainpower. How do we break this cycle? Learning to manage our time, instead of allowing time to manage us, is the key.

There are many time management and organization books and other resources. Unfortunately, many make the reader feel guilty, because it is difficult to complete all of the suggested tasks. Morgenstern [2] stressed that you must take small steps and do things that feel comfortable to you. If you feel guilty and try to adhere to someone else’s style, you are likely to become frustrated. If you find something that works for you, you will feel good about whatever you are able to accomplish and forge ahead. For example, most authors stress the need for filing. This is great if you 1) have a simple filing scheme and 2) have someone to do the filing for you. Otherwise, filing is a time-consuming task that is difficult to maintain over time. From Morgenstern, I learned that my method of “organized piles” is perfectly acceptable as long as I can find items easily. Instead of feeling like a filing failure, I feel successful in my maintenance of orderly heaps.

The Basics of Time Management

The key steps for successful time management are as follows: 1) set realistic goals, 2) get organized, 3) delegate, 4) relax and recharge, and 5) stop feeling guilty. There are two major time management stumbling blocks: procrastination and perfectionism. When we put off tasks (usually distasteful tasks), we often increase our anxiety level, further delaying our work on the task. If we insist on being perfect in every task, we minimize the chance that we will actually complete the task. In fact, perfect is the enemy of good. If 80% of the effort produces 95% of the product, does it really make sense to reach for that final 5%? Will anyone notice? Will it affect the outcome?


The development of goals is critical for personal success. Covey [3] described this as a process to “organize and execute around priorities.” Everyone has both immediate and long-term goals. In many cases, the very short-term goals or tasks supersede long-term goals to the point that individuals may never achieve their lifetime goals. To determine if you have fallen into this trap, write down your top 3 to 5 lifetime goals (Table 1). Next, list 10 things you plan to accomplish in the next week (your to-do list; Table 2). Compare these lists (Table 3): is there anything on your to-do list that relates to your lifetime goals? In the example here, many of the small tasks might ultimately lead to becoming the head of a radiology practice. However, this individual is unlikely to ever get an MBA, learn to play the saxophone, or get to Fiji. For many of us, the lack of correlation of the lists goes on for weeks, months, even years. It is important to work toward your lifetime goals in addition to accomplishing your immediate tasks. This means you must elevate your lifetime goals to higher priorities. Obviously, you cannot ignore many of your weekly activities, but if you don’t perceive that you are not working toward your lifetime goals, you will never accomplish them.

Table 1 

Lifetime goals

1. Become the chair of my department or head of my radiology practice

2. Get an MBA

3. Shoot under 85 in golf

4. Learn to play the saxophone

5. Retire to Fiji at age 60


Table 2 

To do this week

1. Abdominal reading room M, W, Th, F

2. Department and hospital meetings on Tu

3. Finish manuscript for AJR

4. Drive kids’ carpool to school

5. Coach kids’ soccer W night

6. Prepare for MQSA inspection

7. Revise pt safety protocols

8. Prepare presentation for seminar for referring doctors

9. Revise referring physician phone list

10. Grocery store


Table 3 

Lifetime goals related to weekly to-do list

1. Become the chair of my department or head of my radiology practice (weekly items 1, 2, 3, 7, 8, 9)



There are 2 basic components to organization: organizing stuff and organizing time. Both are necessary for success in accomplishing your goals. Disorganization and clutter add to stress. We waste time looking for important information, often failing to find it. We spend too much time repeating tasks, such as reading e-mail. We feel overwhelmed by the number of tasks to complete, and ultimately, we spend too much time worrying about uncompleted tasks. It becomes difficult to distinguish between important and insignificant tasks.

How do you organize stuff? Throw out items—papers, e-mails, files, and so on—that you don’t need. Organize and file (have someone else do the filing whenever possible) so that you can find important items in the future. Unfortunately, organization and filing is an ongoing process, not just a onetime event. That is why it is so important to find an easy system that can be managed in the future. If it is too complicated, you won’t keep at it.

We are all swamped with mail, most of it electronic. It is critically important to learn to manage your mail and e-mail. Strive to handle both once. The 4 D’s for all types of mail are do now, dump, delegate, and delay. Most e-mail can be read and handled immediately by a brief response, forwarding to an appropriate individual, or deletion. Only a minority of items should be delayed. Make a file for mail or messages that you can’t decide how to handle. Review this file periodically. You will find that the majority of this mail never needed action at all. Most of it was unimportant and was taken care of by someone else. If you mistakenly put an important e-mail in your delay file, it will be sent again. Ideally, you were able to recognize the truly important mail when you originally opened it and took care of it immediately.

A problem with doing e-mail on a device such as a Blackberry is that one may find it difficult to deal with long messages and attachments. Thus, the item is opened, closed, and forgotten. The same problem may occur with the use of a laptop. If you have this problem, try to identify messages with attachments or ones that will require concentration, and wait to open them on your laptop or desktop computer.

One of the key components of organization is the management of your calendar. Many of us let our schedules manage us. This is necessary to some degree. For example, if your calendar says you are assigned to the reading room, you must be there. However, if you can learn to manage your schedule to some degree, you will ultimately accomplish more with less anxiety. The first step is to develop a to-do list. It does not matter whether the list is paper or electronic; chose what works best for you. The most important thing is to list everything you need to do and prioritize each item. Be realistic about what you can accomplish within the next day, week, or month. If you overschedule yourself, you will be disappointed when you cannot accomplish every task. Review your to-do list regularly, daily if possible, and revise as necessary.

When you make your list, make time for planning and prioritizing. Schedule time the first thing each morning or the last thing in the evening to plan for the next day or week. It is important to do this daily or weekly because your priorities will change over time.

Determine your most effective mental time and schedule this time to work on important projects. For example, if you are a “morning person,” don’t waste this peak brain time to do e-mail. Instead, use it to work on an important project. Save the e-mail for times when your brain is not maximally efficient. However, don’t do e-mail right before bedtime; an unpleasant message can destroy your sleep for the night.

Break large, important projects into manageable segments. Some people find it helpful to get away from their desks or workstations where they may be distracted by e-mail, phone calls, or cases. However, staying at your desk has the advantages of ready access to your reference materials, files, and so on.

Covey [3] also stressed the determination of urgency and importance in attacking tasks on your to-do list. Decide what is important and what is not. It is also important to decide if a task is urgent or not urgent. Urgent, important tasks should be at the top of your priority list. Unfortunately, we often consume a great deal of time with “easy” activities, which are frequently of low importance.

Time management and organization are not the same as multitasking. Multitasking is widely practiced but is not necessarily a good thing. For example, think of the last time you talked on your cell phone as you drove home. How much of the trip do you remember? It is likely that you remember the phone call more than the driving. Although this may make your trip more enjoyable, it makes it less safe, because your attention is not fully on the road. One definition of multitasking is “doing two things at once by taking twice as long to do them half as well” [4]. It is better to give your full attention to tasks, particularly the important ones.


Before doing a task, ask yourself, “Why me?” Delegate whenever reasonable and possible. The downside of delegating is that you must still check to be sure the task is done, and sometimes it takes longer to tell someone else how to do a task than to do it yourself. Get over the guilt of delegating: think of it as a leadership-building opportunity for others in your practice. Many tasks can be handled effectively (or even more effectively) by others. Don’t use your time to do something that someone else can do more easily or better.


In the current environment of overachievement, overscheduling, and overstimulation, we tend to underestimate the need for mental downtime, relaxation, vacation, and time with friends and family. I often hear criticism that “generation Xers” are too interested in personal time, friends, and families. Those of us who are baby boomers and older should examine whether our work ethic (or “overwork ethic”) is actually better.

Obviously, it is necessary to balance work and relaxation, but what is the cost of overemphasizing the work component of our lives? The balance between work and personal time is delicate but should not be ignored. When we take the time to relax with family and friends, pursue outside interests, and truly “get away,” we recharge and find renewed strength to tackle all of the important tasks.

Ditch Guilt

Etta Pisano [5] published an excellent paper on time management in 2001. She stressed that one of the most important (yet most difficult to accomplish) elements is getting rid of guilt. The guilt may involve things that you don’t get done at home or the office. Many of us are, for some reason, hardwired to feel guilty about all sorts of ridiculous things. However, guilt just leads to stress and anxiety, which lead to more stress and anxiety. Nothing good comes from an unreasonable sense of guilt. In fact, worrying just makes a task take longer and also makes it less pleasant to accomplish. I have learned the hard way not to waste time worrying about a daunting project: just do it!

Stress and feeling of loss of control can lead to anxiety and depression. When you are anxious or depressed, it is even more difficult to manage your time, complete immediate tasks, and accomplish your lifetime goals. If you or those around you find this affecting you, don’t hesitate to get professional help.


The implementation of realistic time management plans can improve productivity and the quality of life. Accept the fact that you are not Superman or Superwoman. Find time to relax, including time to do absolutely nothing. Stop feeling guilty. The result of having adequate “downtime” is a brain that works better during both professional and personal time.

Those are my principles, and if you don’t like them … well, I have others.

—Groucho Marx


Valerie P. Jackson, MDlow asterisk,Indiana University School of Medicine, Indianapolis, Indiana

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